Operationalising the "One Health" approach in India: facilitators of and barriers to effective cross-sector convergence for zoonoses prevention and control

BACKGROUND

There is a strong policy impetus for the One Health cross-sectoral approach to address the complex challenge of zoonotic diseases, particularly in low/lower middle income countries (LMICs). Yet the implementation of this approach in LMIC contexts such as India has proven challenging, due partly to the relatively limited practical guidance and understanding on how to foster and sustain cross-sector collaborations. This study addresses this gap by exploring the facilitators of and barriers to successful convergence between the human, animal and environmental health sectors in India.

METHODS

A mixed methods study was conducted using a detailed content review of national policy documents and in-depth semi-structured interview data on zoonotic disease management in India. In total, 29 policy documents were reviewed and 15 key informant interviews were undertaken with national and state level policymakers, disease managers and experts operating within the human-animal-environment interface of zoonotic disease control.

RESULTS

Our findings suggest that there is limited policy visibility of zoonotic diseases, although global zoonoses, especially those identified to be of pandemic potential by international organisations (e.g. CDC, WHO and OIE) rather than local, high burden endemic diseases, have high recognition in the existing policy agenda setting. Despite the widespread acknowledgement of the importance of cross-sectoral collaboration, a myriad of factors operated to either constrain or facilitate the success of cross-sectoral convergence at different stages (i.e. information-sharing, undertaking common activities and merging resources and infrastructure) of cross-sectoral action. Importantly, participants identified the lack of supportive policies, conflicting departmental priorities and limited institutional capacities as major barriers that hamper effective cross-sectoral collaboration on zoonotic disease control. Building on existing informal inter-personal relationships and collaboration platforms were suggested by participants as the way forward.

CONCLUSION

Our findings point to the importance of strengthening existing national policy frameworks as a first step for leveraging cross-sectoral capacity for improved disease surveillance and interventions. This requires the contextual adaptation of the One Health approach in a manner that is sensitive to the underlying socio-political, institutional and cultural context that determines and shapes outcomes of cross-sector collaborative arrangements.

0758 Quantification of Late REM Periods in Patients With Prolonged Sleep Duration

Introduction

Evaluation of hypersomnia includes polysomnography followed by mean sleep latency testing (MSLT). As consistent with guidelines as applied in most centers, the overnight portion of the study will be terminated to begin sleep latency testing. For patients with prolonged sleep duration, this interruption could result in REM sleep on nap testing that reflects continuation of their biological night, rather than abnormalities in REM sleep pressure/regulation.

Methods

We reviewed 42 consecutive extended (unrestricted) sleep studies for patients with a total sleep time greater than 600 minutes. For studies with sleep onset before midnight, we evaluated for REM period onset after 6AM, the number of REM periods after 6AM and 8AM, and the time of the final REM period onset.

Results

42 hypnograms were reviewed for patients undergoing evaluation of hypersomnia, median age 32 years (range 19-92) with a median total sleep time of 663 minutes (range 602-832), of these 28/42 (67%) had sleep onset before midnight (12 AM) and were included in the analysis. 27/28 (96%) of hypnograms reviewed had REM sleep after 6 AM, 24/28 (86%) had REM sleep after 8 AM, with the onset of the final REM period ranging from 4:46 AM-12:30 PM for patients with sleep onset time before midnight (12 AM).

Conclusion

These data suggest that termination of overnight polysomnography to complete mean sleep latency testing, as is standard in most sleep labs, may influence the presence of REM sleep on MSLT for patients with prolonged total sleep duration. These results may have implications for the interpretation of MSLT for patients with long sleep duration, and may explain why a given individual may test as type II narcolepsy or idiopathic hypersomnia unpredictably on repeat testing.

Support

Sleep Medicine Fellowship at BIDMC

0592 Prevalence of Sleep Apnea in Patients with Tracheobronchomalacia

Introduction

Tracheobronchomalacia (TBM) is a pathologic weakness in the trachea and bronchi leading to excessive dynamic narrowing of the airway. A relationship between sleep disordered breathing (SDB) and TBM has been observed before. SBD may be an important contributor to development or progression of TBM. The objective was to determine the Prevalence and characteristics of sleep disordered breathing in patients with tracheobronchomalacia.

Methods

We performed a retrospective chart review of patients who have been diagnosed with tracheobronchomalacia and who also underwent a polysomnogram (PSG) at the AASM - accredited Sleep Center of Beth Israel Deaconess Medical Center.

Results

In our 24 patient cohort of TBM, 71% were females, mean age 55 years (SD ± 12.3 years) and mean BMI 31.7 kg/m2 (SD ± 9.4 kg/m2). In patients with TBM we found a sleep apnea prevalence of 62.5% (n= 15), defined as an apnea-hypopnea index>5/hour (hour) with a desaturation greater than 4%. Of the 15 patients, 73.3% (n = 11) had mild sleep apnea, 20% (n = 3) had moderate sleep apnea, 6.6% (n = 1) had severe sleep apnea, defined per the AASM criteria with oxygen desaturation greater than 4%. The TBM cohort had a mean sleep efficiency of 72.7% (SD ± 22.2%) with a mean REM of 16.3% (SD ± 9.8 %). Other characteristics included a median AHI 3% of 19.9/hour (95% CI 3.9 - 25.0), median AHI 4% of 5.5/hour (95% CI 3.9 - 9.3), Respiratory disturbance index of 22/hour (95% CI 15.1 to 28.4). No unique challenges for treatment with positive airway pressure were noted.

Conclusion

Sleep apnea may be more common in patients with tracheobronchomalacia and could be regularly screened.

Support

none

g-FLUA2H: a web-based application to study the dynamics of animal-to-human mutation transmission for influenza viruses

g-FLUA2H is a web-based application focused on the analysis of the dynamics of influenza virus animal-to-human (A2H) mutation transmissions. The application only requires the viral protein sequences from both the animal and human host populations as input datasets. The comparative analyses between the co-aligned sequences of the two viral populations is based on a sliding window approach of size nine for statistical significance and data application to the major histocompatibility complex (MHC) and T-cell receptor (TCR) immune response mechanisms. The sequences at each of the aligned overlapping nonamer positions for the respective virus hosts are classified as four patterns of characteristic diversity motifs, as a basis for quantitative analyses: (i) "index", the most prevalent sequence; (ii) "major" variant, the second most common sequence and the single most prevalent variant of the index, with at least one amino acid mutation; (iii) "minor" variants, multiple different sequences, each with an incidence (percent occurrence) less than that of the major variant; and (iv) "unique" variants, each with only one occurrence in the alignment. The diversity motifs and their incidences at each of the nonamer positions allow evaluation of the mutation transmission dynamics and selectivity of the viral sequences in relation to the animal and the human hosts. g-FLUA2H is facilitated by a grid back-end for parallel processing of large sequence datasets. The web-application is publicly available at http://bioinfo.perdanauniversity.edu.my/g-FLUA2H. It can be used for a detailed characterization of the composition and incidence of mutations present in the proteomes of influenza viruses from animal and human host populations, for a better understanding of host tropism.

Historical and political overview

There are more than 10 million local government workers in the United States. Municipal workers are exposed to a wide variety of serious chemical, biological, physical, ergonomic, and safety hazards. Decisions made by legislative bodies and policy makers historically have had a severe impact on the health and safety of local government workers. In over half of the states, city workers are not covered by safety and health programs approved by the Occupational Safety and Health Administration. They also lack universal coverage under laws providing union recognition and the right to collectively bargain over working conditions. Collective action in the workplace and the political arena remains the most important vehicle for municipal workers to secure safe working conditions.

[Genesis and political background of "Sonderaktion Krakau" 6 XI 1939]

The decision to imprison Cracow's University professors on November 6, 1939 was made in connection with the establishment of the so-called General Government, as a second stage of German security police action in nazi-occupied Poland to ensure German rule also over Central and Southern Poland. By this way Sonderaktion Krakau (Special Action Cracow)--as continuation of politische Flurbereinigung (political cleaning up) started in German occupied Western Poland in September 1939--was a part of a second wave of persecution directed against the Polish societies' social classes indicated by Nazi leaders and chiefs of German security police as Poland's leadership, a wave of persecution now, since the end of October 1939, enlarged on Central and Southern Poland. The imprisonment of the Cracow Professors subsequently marked the perspective, that Poland's scientific and academic institutions as a whole would be destroyed, so that in future no Polish scientists, intellectuals and university people even would have the possibility to do scientific work and to have subsistence from doing this kind of work. As a consequence, Poland's intellectuals and university-trained people as a social class in future would disappear indefinitely, and the people of Poland, deprived of intellectual leadership, would be transformed into a mass of dependend lower-class working people, so that the Nazi leaders mournfull future-scenario for their rule in German occupied Central and Eastern Europe would become reality. By this way the imprisonment of the Cracow Professors on November 6, 1939 was the first step to realize Nazi future plans concerning Central and Eastern Europe.

Parental bereavement: spiritual connections with deceased children

Of a sample of 43 bereaved parents of pediatric cancer patients, 38 reported experiencing feelings of continued connection with their deceased child. Analysis of the data revealed several consistent themes in the experiences and in their impact on the parental bereavement process. Implications for research and clinical practice are discussed.

Regulation of sn-1,2-diacylglycerol second-messenger formation in thrombin-stimulated human platelets. Potentiation by protein kinase C inhibitors

Stimulation of platelets with thrombin leads to rapid degradation of inositol phospholipids, generation of diacylglycerol (DAG) and subsequent activation of protein kinase C (PKC). Previous studies indicated that prior activation of PKC with phorbol myristate acetate (PMA) desensitizes platelets to thrombin stimulation, as indicated by a decreased production of inositol phosphates and decreased Ca2+ mobilization. This suggests that PKC activation generates negative-feedback signals, which limit the phosphoinositide response. To test this hypothesis further, we examined the effects of PKC activators and inhibitors on thrombin-stimulated DAG mass formation in platelets. Pretreatment with PMA abolishes thrombin-stimulated DAG formation (50% inhibition at 60 nM). Pretreatment of platelets with the PKC inhibitors K252a or staurosporine potentiates DAG production in response to thrombin (3-4-fold) when using concentrations required to inhibit platelet PKC (1-10 microM). K252a does not inhibit phosphorylation of endogenous DAG or phosphorylation of a cell-permeant DAG in unstimulated platelets, indicating that DAG over-production is not due to inhibition of DAG kinase. Sphingosine, a PKC inhibitor with a different mechanism of action, also potentiates DAG formation in response to thrombin. Several lines of evidence indicate that DAG formation under the conditions employed occurs predominantly by phosphoinositide (and not phosphatidylcholine) hydrolysis: (1) PMA alone does not elicit DAG formation, but inhibits agonist-stimulated DAG formation; (2) thrombin-stimulated DAG formation is inhibited by neomycin (1-10 mM) but not by the phosphatidate phosphohydrolase inhibitor propranolol; and (3) no metabolism of radiolabelled phosphatidylcholine was observed upon stimulation by thrombin or PMA. These data provide strong support for a role of PKC in limiting the extent of platelet phosphoinositide hydrolysis.